Medical device with natural language processor

ABSTRACT

An external medical device is provided. The external medical device includes a memory and circuitry, in communication with the memory, to receive input specifying at least in part at least one prompt relating to a health survey for a patient, the at least one prompt being customized based on to the patient; convert the at least one prompt to an audio representation; and perform the health survey by at least delivering to the patient the audio representation.

RELATED APPLICATIONS

The present application claims priority under 35 U.S.C. §119(e) to U.S.Provisional Application Ser. No. 62/025,660, titled “WearableDefibrillator,” filed on Jul. 17, 2014, which is hereby incorporatedherein by reference in its entirety. The present application claimspriority under 35 U.S.C. §119(e) to U.S. Provisional Application Ser.No. 62/021,609, titled “Wearable Defibrillator,” filed on Jul. 7, 2014,which is hereby incorporated herein by reference in its entirety.

BACKGROUND

1. Technical Field

This disclosure relates to medical devices, and more particularly tomedical devices that include user interfaces.

2. Discussion

Modern medical devices embody a variety of user interface components.These user interface components may include both input and outputcomponents. Examples of components that generate sensory output includevisual displays, speakers, and electromechanical vibrators. Examples ofcomponents that receive input include touch screens, buttons, andswitches. In combination, these inputs and outputs enable users, such aspatients, care providers, and others, to setup and operate medicaldevices to the benefit of patients.

SUMMARY

Some aspects and examples disclosed herein implement a user interface inwhich communications are exchanged between a medical device and a userin a natural language (e.g., spoken/verbal communication in anylanguage, sign language for the hearing impaired, and/or Braille for thevisually impaired). For example, medical devices in accord with someexamples store data descriptive of one or more prompts to be provided toa user to initiate a response from the user. Each of the one or moreprompts may include one or more words, phrases, or sentences rendered asone or more declaratives, interrogatories, imperatives, or exclamations.The data descriptive of the one or more prompts may be stored as encodeddata, such as text, that is decoded by a natural language processingcomponent. In some examples, the natural language processing componentrenders the one or more prompts as audio prompts via a speaker or someother audio or tactile output device. In some examples, the naturallanguage processing component renders the one or more prompts as signlanguage via a display, such as a touch screen.

In some examples, sets of these prompts are grouped together to formcustomized health surveys, instructions, and training materials. Thetraining materials may cover normal usage of the external medical deviceand maintenance topics, such as battery replacement, garment care,assembly/attachment of components, and the like. In these examples, theprompts included in a customized health survey may be selected by a userin view of the medical history and current condition of a patient. Insome examples, prompts included in training materials and instructionsmay be selected by a user in view of an operational issue with themedical device (e.g., maintenance that needs to be performed) or aninability of a user to accomplish some objective regarding the medicaldevice (e.g., the user has been unable to silence an alarm emitted bythe medical device).

In some examples, an external medical device is provided. The externalmedical device includes a memory and circuitry, in communication withthe memory, to receive input specifying at least in part at least oneprompt relating to a health survey for a patient, the at least oneprompt being customized based on to the patient; convert the at leastone prompt to an audio representation; and perform the health survey byat least delivering to the patient the audio representation.

In the external medical device, the circuitry may include circuitry toprovide a user interface including a set of selectable prompts directedto a condition of the patient. The circuitry may include circuitry todetermine, based on the input, a time period for the health surveycomprising the at least one prompt relating to the health survey; andschedule the health survey for the patient during the time period. Thecircuitry may include circuitry to determine the time period based on anoperating mode of the device. The circuitry may include circuitry todetermine the time period based on an operating mode of the device,wherein the operating mode includes a health survey mode and the timeperiod based on the health survey mode is as soon as possible.

In the external medical device, the input may specify the target timeperiod. The input may omit the target time period and the circuitry mayinclude circuitry to store the target time period as a default timeperiod. The circuitry may include circuitry to output the at least oneaudio representation during the target time period. The circuitry mayinclude circuitry to receive at least one response to the at least oneprompt, record the at least one response, determine results based on theat least one response, and provide the results to an external entity viathe user interface. The circuitry to receive the at least one responsemay include circuitry to process audio representations. The circuitrymay includes circuitry to receive at least one response to the at leastone prompt and output an audio representation of at least one otherprompt based on the at least one prompt and the at least one response.

In the external medical device, the at least one prompt may include aplurality of prompts. The circuitry may include a global positioningsystem (GPS) receiver and circuitry to receive a location identifierfrom the GPS receiver, to determine a language associated with thelocation, and the audio representation is converted to the language. Thetarget time period may include a reoccurring time period. The circuitrymay include circuitry to receive at least one response to the at leastone prompt, identify the at least one response as at least oneaddressable response, and address the response.

The external medical device may further include a cross-reference storedin the memory. The cross-reference may include associations betweenresponse types and addresses for target recipients. The circuitry of theexternal medical device may include circuitry to receive at least oneresponse to the at least one prompt, to identify at least one responsetype of the at least one response, to identify at least one address forat least one target recipient from the cross-reference using the atleast one response type, and to transmit at least one notification tothe at least one target recipient.

In some examples, the cross-reference may include associations betweenresponse types and addresses for target recipients. The circuitry of theexternal medical device may include circuitry to receive at least oneresponse to the at least one prompt, to identify at least one responsetype of the at least one response, to identify at least one address forat least one target recipient from the cross-reference using the atleast one response type, and to transmit at least one notification tothe at least one target recipient, the target recipient being a deviceassociated with at least one of a healthcare provider, support provider,and care taker and the notification including an natural languagerepresentation of at least one of a name of the patient, a location ofthe patient, a condition of the patient, and the at least one response.

In some examples, the cross-reference may include associations betweenresponse types and priorities for subsequent actions. The circuitry ofthe external medical device may include circuitry to receive at leastone response to the at least one prompt, to identify at least oneresponse type of the at least one response, to identify at least onepriority from the cross-reference using the at least one response type,and to transmit at least one notification with the at least onepriority.

In some examples, an external medical device is provided. The externalmedical device includes a memory and circuitry, in communication withthe memory, to monitor one or more indicators of a patient's health,detect a potential health condition based on the one or more indicators,identify at least one prompt associated with the potential condition,generate audio output conveying the at least one prompt, receive aresponse to the at least one prompt, and adjust a configurable parameterof the external medical device based on the at least one prompt and theresponse.

In the external medical device, the one or more indicators may includeone or more indicators of cardiac function, respiratory function, andvocal function. The configurable parameter may define a course oftreatment executed by the external medical device to treat the potentialhealth condition. The potential health condition may include at leastone of ventricular tachycardia, ventricular fibrillation, bradycardia,and asystole.

In some examples a system is provided. The system includes a computersystem including a memory and circuitry, in communication with thememory, to provide a user interface including a set of selectableprompts directed to a condition of an external medical device, eachselectable prompt of the set of selectable prompts corresponding to textarticulating the selectable prompt; receive input selecting at least oneprompt from the set of selectable prompts to include in a trainingmessage directed to the condition; and transmit the training message tothe external medical device. The system also includes the externalmedical device. The external medical device includes a memory andcircuitry, in communication with the memory, to receive the trainingmessage, convert the text corresponding to the at least one prompt to atleast one natural language representation of the at least one prompt,and output the at least one natural language representation. In thesystem, the condition may include a low battery and the at least oneprompt may include a request to change the battery.

It is appreciated that various examples described herein provide a hostof advantages over conventional technology. These advantages includeclinical flexibility, the ability to upgrade devices “on the fly” (e.g.,without requiring physical access to the device by technicians), and theability to rapidly deploy devices to new markets (e.g., withoutrequiring loading of different audio files, which may consumesubstantial storage).

Still other aspects and advantages of the examples disclosed herein arediscussed in detail below. Moreover, it is to be understood that boththe foregoing information and the following detailed description aremerely illustrative examples of various aspects, and are intended toprovide an overview or framework for understanding the nature andcharacter of the claimed subject matter. Any example disclosed hereinmay be combined with any other example. References to “an example,”“some examples,” “an alternate example,” “various examples,” “oneexample,” “at least one example,” “this and other examples” or the likeare not necessarily mutually exclusive and are intended to indicate thata particular feature, structure, or characteristic described inconnection with the example may be included in at least one example. Theappearances of such terms herein are not necessarily all referring tothe same example.

Furthermore, in the event of inconsistent usages of terms between thisdocument and documents incorporated herein by reference, the term usagein the incorporated references is supplementary to that of thisdocument; for irreconcilable inconsistencies, the term usage in thisdocument controls. In addition, the accompanying drawings are includedto provide illustration and a further understanding of the variousaspects and examples, and are incorporated in and constitute a part ofthis specification. The drawings, together with the remainder of thespecification, serve to explain principles and operations of thedescribed and claimed aspects and examples.

BRIEF DESCRIPTION OF DRAWINGS

The accompanying drawings are not intended to be drawn to scale. In thedrawings, components that are identical or nearly identical may berepresented by a like numeral. For purposes of clarity, not everycomponent is labeled in every drawing. In the drawings:

FIG. 1 is a functional schematic one example of an external medicaldevice controller;

FIGS. 2A-B are illustrations of one example of an external medicaldevice controller for an external medical device;

FIG. 3 is an illustration of one example of an external medical device;

FIG. 4 is an illustration of one example of an external medical device;

FIG. 5 is a block diagram of one example of a distributed promptingsystem;

FIG. 6 is a block diagram of one example of a distributed computingsystem;

FIG. 7 is an illustration of one example of a health surveyconfiguration screen;

FIG. 8 is an illustration of one example of a health survey resultsscreen;

FIG. 9 is an illustration of one example of health survey resultsscreen; and

FIG. 10 is a flow diagram of one example of a prompting process.

DETAILED DESCRIPTION

Medical devices in accord with various examples disclosed herein usenatural language to interact with external entities, such as patientsbeing monitored by the medical devices, other users of the medicaldevices such as health care professionals and patient servicerepresentatives, and third parties, such as bystanders. For instance,according to some examples, an external medical device includes anatural language processing component configured to read informationdescriptive of one or more prompts and articulate the one or moreprompts in a natural language, such as through audio output or visualgestures (e.g., sign language). In some examples, the natural languageprocessing component is also configured to detect responses in a naturallanguage, e.g., spoken audio, and convert the natural language intoencoded data, such as human-readable text, for storage and furtherprocessing. Further, in some examples, the natural language processingcomponent is configured to analyze the responses, address the responsesby, for example, altering the operation of the external medical device,and report responses to the prompts. In various examples, prompts may bedefined by a user of the system and, accordingly, include customprompts.

Some examples use this natural language processing capability to enhancepatient care. For instance, according one example, a medical device isconfigured to receive information descriptive of a health surveycustomized for one or more target patients. This health surveyinformation may identify one or more prompts for informationspecifically selected for the one or more target patients. In someexamples, the medical device is configured execute the health survey byissuing the one or more identified prompts and recording any responsesreceived to the prompts.

In some examples, the medical device is configured to analyze theresponses and identify whether any of the responses should be addressed.In these examples, the medical device is further configured to addressthe responses according to custom prompt information stored in themedical device. For example, if a response indicates that the patientrequires assistance, the medical device may contact an external entityidentified in the custom prompt information to request assistance onbehalf of the patient.

In some examples, the medical device is configured to receiveinformation descriptive of one or more instructions or morecomprehensive training (e.g., comprising a set of instructions as aself-contained training module) customized for one or more targetrecipients. This training information may identify one or more promptsfor information or action specifically selected for the one or moretarget recipients. For example, the training information may be directedto an activity associated with the medical device that a patient ishaving difficulty in performing. In some examples, the medical device isconfigured to provide the instructions or training by issuing the one ormore identified prompts through natural language output, such as audiooutput.

For example, any of the medical devices disclosed herein may benon-invasive or ambulatory. As used herein, the term non-invasive is incontrast to invasive devices, such as implantable medical devices. Forexample, non-invasive medical devices disclosed herein can includewearable medical devices. The term ambulatory means that the device iscapable of and designed for moving with the patient.

The examples of the methods and apparatuses discussed herein are notlimited in application to the details of construction and thearrangement of components set forth in the following description orillustrated in the accompanying drawings. The methods and apparatusesare capable of implementation in other examples and of being practicedor of being carried out in various ways. Examples of specificimplementations are provided herein for illustrative purposes only andare not intended to be limiting. In particular, acts, elements andfeatures discussed in connection with any one or more examples are notintended to be excluded from a similar role in any other examples.

Also, the phraseology and terminology used herein is for the purpose ofdescription and should not be regarded as limiting. Any references toexamples or elements or acts of the systems and methods herein referredto in the singular may also embrace examples including a plurality ofthese elements, and any references in plural to any example or elementor act herein may also embrace examples including only a single element.References in the singular or plural form are not intended to limit thepresently disclosed systems or methods, their components, acts, orelements. The use herein of “including,” “comprising,” “having,”“containing,” “involving,” and variations thereof is meant to encompassthe items listed thereafter and equivalents thereof as well asadditional items. References to “or” may be construed as inclusive sothat any terms described using “or” may indicate any of a single, morethan one, and all of the described terms.

Example Medical Device Controller

Various examples disclosed herein use natural language processing tocommunicate prompts in a natural language and receive verbal and/ornon-verbal responses through textual input (e.g., user selects one ormore predefined responses or types in a response via a user interface)or natural language input (e.g., user speaks desired response or speaksselection of one or more predefined responses). Target recipients forthese prompts may include patients being monitored by the externalmedical device, care givers for the patient, or third party bystanders,among others. FIG. 1 illustrates an external medical device controller102 in accord with some examples. The external medical device controller102 may be included in any of a variety of external medical devicesincluding defibrillators, monitors, CPR systems, pacing devices, andother medical devices. More specific examples of medical devicesincluding a controller in accord with the external medical devicecontroller 102 are described further below with reference to FIGS. 3-5.In these examples, the external medical device controller 102 isconfigured for use in a wearable defibrillator or an Automated ExternalDefibrillator (AED).

As shown in FIG. 1, the external medical device controller 102 includesat least one processor 118, a sensor interface 114, a natural languageprocessing component 112, a therapy delivery interface 116, data storage104, a network interface 106, a user interface 108, and a battery 110.The processor 118 can be implemented using a variety of commerciallyavailable processors or other circuitry. Specific examples of theprocessor 118 are described further below. The data storage 104 includescustom prompt data 120. The sensor interface 114 can include an acousticsignal processing component, an electrode signal processing component,and motion signal processing component, among other signal processingcomponents. In some implementations, components such as natural languageprocessing component 112 and sensor interface 114 can be at leastpartially implemented within the processor 118. In some implementations,the components can be implemented in circuitry that is separate fromprocessor 118. For example, in one example the natural languageprocessing component 112 includes voice circuitry in communication witha memory of the controller 102 and configured to perform the one or moreprocesses as described herein. As referred to herein, “circuitry” mayinclude controllers, processors, transistors, integrated circuits,microprocessors, and the like. As such, some forms of circuitry can beconfigured by various software components to execute particular featuresand functions. As discussed further below, these software components maybe stored in the data storage 104 or in an on-board storage element inprocessor 118.

In some examples in accord with FIG. 1, the battery 110 may be arechargeable 3 cell 2200 mAh lithium ion battery pack that provideselectrical power to the other device components with at least 24 hourruntime between charges. It is appreciated that the battery capacity,runtime, and type (e.g., lithium ion, nickel-cadmium, or nickel-metalhydride) may be changed to best fit the specific application of themedical device controller 102.

According to the example illustrated in FIG. 1, the processor 118 can becoupled to and in data communication with one or more of the sensorinterface 114, the therapy delivery interface 116, the data storage 104,the network interface 106, and the user interface 108. In some examples,the processor 118 performs a series of instructions that result inmanipulated data which are stored in and retrieved from the data storage104. According to a variety of examples, the processor 118 is acommercially available processor such as a processor manufactured byTexas Instruments, Intel, AMD, Sun, IBM, Motorola, Freescale, and ARMHoldings. However, the processor 118 may be any type of processor,multiprocessor or controller, whether commercially available orspecially manufactured. For instance, according to one example, theprocessor 118 may include a power conserving processor arrangement asdescribed in U.S. Pat. No. 8,904,214, titled SYSTEM AND METHOD FORCONSERVING POWER IN A MEDICAL DEVICE, issued Dec. 2, 2014, which ishereby incorporated herein by reference in its entirety. In one example,the processor 118 is an Intel® PXA270.

In addition, in several examples, the processor 118 is configured toexecute a conventional operating system. The operating system mayprovide platform services to application software, such as some examplesof the natural language processing component 112 which is discussedfurther below. These platform services may include inter-process andnetwork communication, file system management and standard databasemanipulation. One or more of many operating systems may be used, andexamples are not limited to any particular operating system or operatingsystem characteristic. For instance, in some examples, the processor 118may be configured to execute a real-time operating system (RTOS), suchas RTLinux, or a non-real time operating system, such as BSD orGNU/Linux.

In various examples, the sensor interface 114 is configured to couple toand receive acoustic signals from an acoustic sensor. Similarly, thesensor interface 114 may be configured to couple to and receiveelectrode signals from one or more electrodes. These electrodes maycomprise any of a variety of commercially available electrodes, someexamples of which are described further below. As illustrated in FIG. 1,in some examples, the natural language processing component 112 can becoupled with and receive processed acoustic data from the sensorinterface 114 via the processor 118. Similarly, the natural languageprocessing component 112 may be coupled with and receive response datafrom the user interface 108 or the sensor interface 114 via theprocessor 118. In various examples, the response data is descriptive ofverbal responses to one or more communicated prompts.

Natural Language Processing Component

According to one example illustrated by FIG. 1, the natural languageprocessing component 112 is configured to receive an identifier of textor other encoded data specifying at least one prompt to be communicatedto a patient monitored by the external medical device. As discussed inmore detail below, the natural language processing component 112 mayperform a natural language generation process to convert the receiveddata to a prompt or an instruction. For example, prompts can take theform of questions in a health survey, instruction and training messages,or device maintenance-related topics. In various examples, the naturallanguage processing component 112 is configured to generate an outputconveying at least one prompt to the user (e.g., a patient), and receivea response to the at least one prompt. For example, as described indetail below, the output prompt may be a spoken question in a languageof the user, and the user's response may be received via a microphoneassembly in the user interface 108 and processed by the natural languageprocessing component 112. In one example, the prompt can be communicatedto the patient during a predetermined target time period or a defaulttime period. The time period may be configured in the form of a singlediscrete time or a time range, and may include non-reoccurring orreoccurring time periods.

In one example, the external medical device controller 102 is configuredto determine the time period for delivering the health survey based onan operating mode of an associated external medical device. The devicemay include one or more predetermined operating modes, such as a healthsurvey mode. In various examples, each of the one or more operatingmodes controls the behavior of the device its operation. Modes may beactivated by default or through user interaction with the user interface108 that causes the user interface 108 to store a value in aconfigurable parameter that defines the operating mode. For example, inone implementation the external medical device controller 102 isconfigured to determine that the operating mode of the device ispresently the health survey mode by referencing the value of theconfigurable parameter and to cause the health survey to beautomatically performed during the health survey mode. As describedabove, this can include automatically communicating a prompt at adetermined target time period (e.g., as soon as possible).

Similarly, in some examples, the external medical device controller 102includes additional modes in which the natural language processingcomponent 112 interacts with users. For instance, in some examples theexternal medical device controller 102 implements a maintenance mode inwhich the external medical device controller 102 issues prompts to theuser to aid the user in performing maintenance functions such as batteryreplacement, component assembly, garment care, and the like. Moreover,in some examples, the external medical device controller 102 implementsa training mode in which the external medical device controller 102issues prompts to the user to train the user on how to operate theexternal medical device in which the external medical device controller102 is housed.

The natural language processing component 112 may also perform naturallanguage understanding to convert the user's response to a binaryrepresentation of a human readable symbol, such as text, for, e.g.,storage and later retrieval. In various other examples, the naturallanguage component 112 is configured to receive a transmission includingcustom prompt data specifying at least one message and convert the datato an audio representation of the at least one message. For example, adoctor may customize one or more prompts based on a patient's underlyingcondition. The doctor may customize prompts by, e.g., speaking his/herquestions into the device microphone. The doctor may be given audio orvisual feedback regarding the spoken question, e.g., human readable textrendering of the question can be displayed to the doctor, oralternatively the doctor's recorded question may be played back to him.The doctor may then accept or reject the recording.

In various examples, the audio output, or audio representation, may beoutput by the user interface 108 and communicated to the patientmonitored by the external medical device. Processes performed by thenatural language processing component 112 are described in detail belowwith reference to FIG. 10.

In various examples, the natural language processing component 112 isconfigured to modify and adjust prompts based on language basedparameters, location information associated with an external medicaldevice, or the response received to at least one prompt. Language basedparameters may indicate primary language, dialect, spoken word, signlanguage, gender of voice, speed of diction, accent, and vocabulary/wordchoice. Language based parameters may be received from a user of theexternal medical controller 102, such as the patient, through one ormore interfaces such as the user interface 108. Accordingly, in one ormore examples, the external medical device controller 102 includes aconfigurable parameter storing a value that specifies a one or morelanguages in which the external medical device controller 102communicates. By setting this configurable parameter to one or morepredefined values, a user may manually select one or more languagesthrough which the external medical device controller 102 communicatesprompts

Location information may include information descriptive of a geographiclocation, such as an address, a state, a country, etc. In one example,location information may be received through antennas integrated with orcoupled to the network interface 106, and consequently coupled to theprocessor 118. For example, the one or more antennas may receive GPSsignals from satellites. In various examples, the natural languageprocessing component 112 can also determine language based parametersfrom a response to the prompt. For example, the natural languageprocessing component 112 may perform natural language understanding todetermine that the response to a prompt is in a particular dialect. Infurther examples, the natural language processing component 112 maydetermine a natural language associated with a location identified byreceived GPS signals. Accordingly, various examples of the naturallanguage processing component 112 modify and adjust prompts toaccommodate a particular patient. In various examples, this includestranslating a prompt to a language that the patient has spoken or isknown to understand. While in some examples this may include spokenlanguage, in further examples this may include non-spoken languages,such as sign language. While discussed herein in the context of a singleverbal or non-verbal language, various examples of the controller 102may communicate, modify, and adjust prompts in a plurality of naturallanguages. For example, responsive to receiving a GPS signal, thecontroller 102 can determine that more than one natural language isassociated with the location corresponding to the GPS signal.Accordingly, prompts can be tailored to each language associated withthe particular location. For example, several translations of a singleprompt may be communicated. Furthermore, prompts may be communicated inboth verbal and non-verbal languages (e.g., English and American signlanguage or ASL).

According to one example illustrated by FIG. 1, the natural languageprocessing component 112 may be further configured to detect the rhyme,meter, pitch, or pace of expression, or respiration of the patient toaid in determining the patient's status. The natural language processingcomponent 112 may include circuitry configured to detect speech orrespiration exhibited in patient responses and to identify a conditionbased on a comparison of the detected speech or respiration and abenchmark. In one example, the circuitry is coupled with and receivesresponse data from the user interface 108 via the processor 118. In thisexample, the circuitry measures and compares an envelope of receivedresponse data to a benchmark specifying characteristics of breathing orspeech (e.g., breath rate, volume patterns, etc.) associated with aparticular health condition. In some examples, the circuitry may furthercompare processed acoustic data and processed electrode data tobenchmarks to identify the presence or absence of particular healthconditions. Identified breathing or speech may additionally be trackedto determine trends in patient's speech or respiration. Detection andevaluating breathing or speech patterns, permits the natural languageprocessing component 112 to diagnose and track health conditions such ascongestive heart failure, or other symptoms associated with cardiacdysfunction. In some examples, the medical device controller 102 canadjust a device parameter in response to the detected speech and/orrespiration patterns (e.g., audible labored breathing) of the patient.For example, in addressing a patient's response to a custom prompt, themedical device controller 102 may detect one or more speech and/orrespiration patterns that indicate an underlying health condition andalter a course of treatment or perform some other action. For example,the controller 102 delay or expedite the administration of pacing pulsesand/or defibrillation treatment, adjust a configurable operationalparameter of the external medical device, prompt a third party to takeaction via a natural language prompt such as requesting emergencyback-up, and/or reporting the event and information regarding thepatient, such as location, identity, and vital signs).

For example, if the patient is experiencing labored breathing during anactivity (e.g., a device-guided six-minute walk test), the controller102 can use one or more detected speech patterns to suggest to thepatient, caregiver, or other user, that the patient should slow down orstop the activity. In some implementations, the controller 102 cancombine the detected speech patterns with other sensed information(e.g., using the acoustic signal processing component in sensorinterface 114) and determine an appropriate course of action based onthe combination of the detected speech patterns and other sensedinformation. For example, the controller 102 may determine that thepatient's breathing is labored through one or more speech patterns inthe patient's response to a prompt and, if lung sounds detected byacoustic signal processing component confirms the determination, thecontroller 102 may advice the patient to stop performing the activity.In other examples, a heart rate detector may provide additionalcorrelating information, e.g., detecting if patient's heart rate exceedsa threshold (such as 150 bpm).

The natural language processing component 112 may be implemented usinghardware or a combination of hardware and software. For instance, in oneexample, the natural language processing component 112 is implemented asa software component that is executed by the processor 118. In thisexample, the instructions included in the natural language processingcomponent 112 program the processor to derive meaning from human(natural) language, such text or as a response to a prompt. Forinstance, this may include converting a computer based representationinto a natural language representation (i.e., natural languagegeneration) or converting received natural language into a computerbased representation (i.e., natural language understanding). In variousexamples the natural language processing component 112 includes alexicon of language, a parser, and grammar rules. Additionally, thenatural language processing component 112 may reference a semantictheory to guide natural language understanding processes executed by thenatural language processing component 112. In various examples, asemantic theory characterizes a sentence based on its structure andcontext.

During natural language understanding, the natural language processingcomponent 112 first executes a process of decomposing the response intophonemes. This may be performed by the parser. Phonemes include any ofthe units of sound in a language that distinguish one word from another.For example, the English language has roughly 40 phonemes. Each phonemeis then identified in the lexicon of language and assessed according tothe grammar rules and semantic theory. Accordingly, phonemes are matchedto spoken words based on the particular rules and theory. Alternatively,the natural language processing component 112 can be configured toperform statistical modeling using probability and mathematicalfunctions to determine the most likely match between phonemes and words.For example, this may include the Hidden Markov Model or neuralnetworks. Statistical modeling accommodates for accents, dialects, andmannerisms that may change between users. Responsive to the matchingphonemes to spoken words, the sentence may be reconstructed in acomputer based representation.

In contrast, during natural language generation phonemes are assigned totext. In various examples the natural language processing component 112includes a store of voice references including all of the phonemes andvoice references for a given language. Initially, the text next goesthrough a process of tokenization. This process divides the text intobasic language units such as words or morphemes. This may be performedby the parser, for example. A morpheme is the smallest grammatical unitof a language. Divisions are generally made using separators such aspunctuation marks and spaces in the text. The natural languageprocessing component 112 then performs one or more processes that assigna phonetic transcription to the text to reconstruct each word. Thisprocess may be referred to as text-to-phoneme processing. Grammaticaland syntactic analysis based on at least the grammar rules and semantictheory enables the natural language processing component to reconstructthe sentence and output an audio waveform.

As discussed above, various examples of the natural language processingcomponent 112 may perform speech synthesis processes that convert customprompts in a text format to one or more verbal prompts (e.g., artificialspeech). Accordingly, the natural language processing component 112 ofone example can include a speech synthesizer, such as a text-to-speechconverter that converts normal language text into speech. Thetext-to-speech converter generates synthesized speech by referencing adatabase of stored speech and linking together individual segments ofrecorded speech (e.g., phonemes) to construct words and sentences. Invarious implementations the text-to-speech converter is implemented in ahardware product. For example, the text-to-speech converter may includethe Textspeak TTS-EM offered by TextSpeak of Westport, Conn. or theEpson S1V30120F01A100, offered by EPSON® of Long Beach, Calif. In otherexamples, the text-to-speech converter is implemented in a softwareproduct. As described above with reference to the natural languageprocessing component 112 of FIG. 1, various examples of thetext-to-speech converter convert the raw text (e.g., custom prompts) tothe equivalent of written words (i.e, tokenization). Phonetictranscriptions are then assigned to each word (i.e., text-to-phoneme).The text-to-speech converter then divides the text into phrases,clauses, and sentences and converts the resulting sentence into sound(i.e., synthesization). Often this includes the computation of pitchcontour and duration of particular phonemes in the resulting sentence.

In some examples, the natural language processing component 112 isconfigured to identify at least one response type of a response receivedand identify at least one address for a target recipient associated withthe response type in a cross-reference stored in memory. Thecross-reference may include associations between a response type and oneor more addresses for one or more target recipients. The naturallanguage processing component 112 may be configured to transmit at leastone notification to the target recipient based on an identified address.These notifications may be communicated, for instance, via networkinterface 106. In one example, the target recipient includes a deviceassociated with a healthcare provider, care taker, or support personnel,and the notification includes a natural language representation of atleast a name of a patient, a location of the patient, a condition of thepatient, or the response. In a further example, the natural languageprocessing component 112 may identify a priority from a cross-referencebased on the response type, and transmit the associated notificationwith the priority identified.

As described above, the custom prompt data 120 includes identifiers ofpreviously defined prompts, definitions of new prompts, identifiers ofpreviously defined target events that trigger prompts, definitions ofnew target events that trigger prompts, identifiers of previouslydefined responses to be addressed, definitions of new responses to beaddressed, identifiers of previously defined actions to be taken inaddressing responses, and definitions of new actions to be taken inaddressing responses. More particularly, according to the illustratedexample, the custom prompt data 120 includes at least one promptassociated with a potential health condition of the patient. Forexample, the custom prompt data 120 may include a series of prompts,such as a survey of questions or periodic condition status questionswhich may include, for example: “Are your legs swelling?”; “Are youhaving breathing difficulties?”; “Have you experienced a gain inweight?”; and “Are you sitting up to sleep?”. Additional surveyquestions that may be stored in custom prompt data 120 are discussedfurther below with reference to FIG. 5 and a listing of prompts 506.Various other questions relating to symptoms of health conditions mayalso be used in addition to or in place of such survey questions.

The custom prompt data 120 may also include one or more cross-referencesconfigured by the custom prompt interface described further below. Asused herein, cross-references may consist of a queryable associationbetween one or more identifiers and include a look-up table,hierarchical database, relational database, object oriented database, orthe like.

Diagnostic Information Communications

In addition to the examples discussed above, in various examples thenatural language processing component 112 may cause the controller 102to communicate one or more system diagnostics to the user or patient.Communication may be through one or more interfaces, such as the userinterface 108. System diagnostics may include any message conveying adiagnosed error in the controller 102 or an associated external medicaldevice. In one example, system diagnostics are communicated responsiveto user selection of customer support indicator in the user interface108. Accordingly, when communication between the external medical devicecontroller 102 and a healthcare provider system is compromised, (e.g.,network interface 106 is unable to communicate with the healthcareprovider system) communication of the system diagnostics to the userpermits the user to convey the diagnostics to the healthcare providersystem or a user associated therewith. For example, the user may use apersonal mobile device, such as a smart phone, to relay the diagnosticsto the healthcare provider system or the associated user.

Example Implementations of Components

In other examples, the natural language processing component 112 may bean application-specific integrated circuit (ASIC) that is coupled to theprocessor 118 and tailored to derive meaning from natural language. Forexample, the natural language processing component 112 may includecircuitry to render one or more prompts as audio prompts via the userinterface 108. Thus, examples of the natural language processingcomponent 112 are not limited to a particular hardware or softwareimplementation.

In some examples, the components disclosed herein, such as the naturallanguage processing component 112, may read parameters that affect thefunctions performed by the components. These parameters may bephysically stored in any form of suitable memory including volatilememory, such as RAM, or nonvolatile memory, such as a flash memory ormagnetic hard drive. In addition, the parameters may be logically storedin a propriety data structure, such as a database or file defined by auser mode application, or in a commonly shared data structure, such asan application registry that is defined by an operating system. Inaddition, some examples provide for both system and user interfaces thatallow external entities to modify the parameters and thereby configurethe behavior of the components.

The data storage 104 includes a computer readable and writeablenonvolatile data storage medium configured to store non-transitoryinstructions and data. In addition, the data storage 104 includesprocessor memory that stores data during operation of the processor 118.In some examples, the processor memory includes a relatively highperformance, volatile, random access memory such as dynamic randomaccess memory (DRAM), static memory (SRAM) or synchronous DRAM. However,the processor memory may include any device for storing data, such as anon-volatile memory, with sufficient throughput and storage capacity tosupport the functions described herein. According to several examples,the processor 118 causes data to be read from the nonvolatile datastorage medium into the processor memory prior to processing the data.In these examples, the processor 118 copies the data from the processormemory to the non-volatile storage medium after processing is complete.A variety of components may manage data movement between thenon-volatile storage medium and the processor memory and examples arenot limited to particular data management components. Further, examplesare not limited to a particular memory, memory system, or data storagesystem.

The instructions stored on the data storage 104 may include executableprograms or other code that can be executed by the processor 118. Theinstructions may be persistently stored as encoded signals, and theinstructions may cause the processor 118 to perform the functionsdescribed herein. The data storage 104 also may include information thatis recorded, on or in, the medium, and this information may be processedby the processor 118 during execution of instructions. The medium may,for example, be optical disk, magnetic disk or flash memory, amongothers, and may be permanently affixed to, or removable from, themedical device controller 102.

The data storage 104 may also include sensor data such as such as ECGsignal data, interpretations of the ECG signal data (e.g., heartbeats),analog heart sounds, analog breath sounds, analog motion data, acousticsignals, electrode signals, motion signals, processed motion data,processed acoustic data, and processed electrode data. Sensor data maybe analyzed by one or more system components to detect the occurrence ofa medical condition, such as a cardiac arrhythmia.

As illustrated in FIG. 1, the natural language processing component 112and the custom prompt data 120 are separate components. However, in someexamples, the natural language processing component 112 and the customprompt data 120 may be combined into a single component or re-organizedso that a portion of the data included in the natural languageprocessing component 112, such as executable code, resides in the customprompt data 120, or vice versa. Such variations in these and the othercomponents illustrated in FIG. 1 are intended to be within the scope ofthe examples disclosed herein.

The custom prompt data 120 may be stored in any logical constructioncapable of storing information on a computer readable medium including,among other structures, flat files, indexed files, hierarchicaldatabases, relational databases or object oriented databases. These datastructures may be specifically configured to conserve storage space orincrease data exchange performance. In addition, various examplesorganize the custom prompt data 120 into particularized and, in somecases, unique structures to perform the functions disclosed herein. Inthese examples, the data structures are sized and arranged to storevalues for particular types of data, such as integers, floating pointnumbers, character strings, arrays, linked lists, and the like.

As shown in FIG. 1, the external medical device controller 102 includesseveral system interface components 106, 114, and 116. Each of thesesystem interface components is configured to exchange (i.e. send orreceive) data with one or more specialized devices that may be locatedwithin the housing of the medical device controller 102 or elsewhere.The components used by the interfaces 106, 114, and 116 may includehardware components, software components, or a combination of both.Within each interface, these components physically and logically couplethe medical device controller 102 to the specialized devices. Thisphysical and logical coupling enables the medical device controller 102to communicate with and, in some examples, power or control theoperation of the specialized devices. These specialized devices mayinclude physiological sensors, therapy delivery devices, and computernetworking devices.

According to various examples, the hardware and software components ofthe interfaces 106, 114, and 116 implement a variety of coupling andcommunication techniques. In some examples, the interfaces 106, 114, and116 use leads, cables or other wired connectors as conduits to exchangedata between the medical device controller 102 and specialized devices.In some examples, the interfaces 106, 114, and 116 communicate withspecialized devices using wireless technologies such as radio frequency,infrared technology, and body area network (BAN) technology. Thesoftware components included in the interfaces 106, 114, and 116 enablethe processor 118 to communicate with specialized devices. Thesesoftware components may include elements such as objects, executablecode, and populated data structures. Together, these software componentsprovide software interfaces through which the processor 118 can exchangeinformation with specialized devices. Moreover, in at least someexamples where one or more specialized devices communicate using analogsignals, the interfaces 106, 114, and 116 further include componentsconfigured to convert analog information into digital information, andvice versa, to enable the processor 118 to communicate with specializeddevices.

As discussed above, the system interface components 106, 114, and 116shown in FIG. 1 support different types of specialized devices. Forinstance, the components of the sensor interface 114 couple theprocessor 118 to one or more physiological sensors such as a bodytemperature sensors, respiration monitors, and ECG sensing electrodes,one or more environmental sensors such as atmospheric thermometers,airflow sensors, video sensors, audio sensors, accelerometers, GPSlocators, and hygrometers. In these examples, the sensors may includesensors with a relatively low sampling rate, such as wireless sensors.

The components of the therapy delivery interface 116 couple one or moretherapy delivery devices, such as capacitors, defibrillator electrodeassemblies, pacing electrode assemblies, or mechanical chest compressiondevices, to the processor 118. It is appreciated that the functionalityof the therapy delivery interface 116 may be incorporated into thesensor interface 114 to form a single interface coupled to the processor118.

The components of the network interface 106 couple the processor 118 toa computer network via a networking device, such as a bridge, router orhub. According to a variety of examples, the network interface 106supports a variety of standards and protocols, examples of which includeUSB (via, for example, a dongle to a computer), TCP/IP, Ethernet,Wireless Ethernet, Bluetooth®, ZigBee, M-Bus, CAN-bus, IP, IPV6, UDP,DTN, HTTP, FTP, SNMP, CDMA, NMEA and GSM. It is appreciated that thenetwork interface 106 of external medical device controller 102 mayenable communication between other medical device controllers within acertain range.

To ensure data transfer is secure, in some examples, the externalmedical device controller 102 can transmit data via the networkinterface 106 using a variety of security measures including, forexample, TLS, SSL, or VPN. In some examples, the network interface 106includes both a physical interface configured for wireless communicationand a physical interface configured for wired communication. Accordingto various examples, the network interface 106 enables communicationbetween the external medical device controller 102 and a variety ofpersonal electronic devices including, for example, computer enabledglasses, watches, and earpieces. In these examples, the networkinterface 106 may connect to and communicate through a body areanetwork.

In one example, the network interface 106 is also capable oftransmitting or receiving information to assist in medical devicelocation determination. This may be accomplished through one or moreantennas integrated with or coupled to the network interface 106, andconsequently coupled to the processor 118. For example, the one or moreantennas may receive GPS signals from satellites. The GPS signals may beused to determine the location of the medical device with a given levelof accuracy or used to determine the current time.

Thus, the various system interfaces incorporated in the medical devicecontroller 102 allow the device to interoperate with a wide variety ofdevices in various contexts. For instance, some examples of the medicaldevice controller 102 are configured to perform a process of sendingcritical events and data to a centralized server via the networkinterface 106. An illustration of a process in accord with theseexamples is disclosed in U.S. Pat. No. 6,681,003, titled “DATACOLLECTION AND SYSTEM MANAGEMENT FOR SUBJECT-WORN MEDICAL DEVICES,”issued on Jan. 20, 2004 which is hereby incorporated by reference in itsentirety.

As illustrated in FIG. 1, the therapy delivery interface 116 and thenetwork interface 106 are optional and may not be included in everyexample. For instance, a heart rate monitor may employ the medicaldevice controller 102 to issue alarms but may not include a therapydelivery interface 116 to treat cardiac abnormalities. Similarly, anambulatory defibrillator may include the medical device controller 102to provide defibrillation functionality but may not include a networkinterface 106 where, for example, the ambulatory defibrillator isdesigned to rely on the user interface 108 to announce alarms.

Example User Interface Implementation

The user interface 108 shown in FIG. 1 includes a combination ofhardware and software components that allow the medical devicecontroller 102 to communicate with an external entity, such as a patientor other user. These components may be configured to receive informationfrom actions such as physical movement, verbal intonation, or thoughtprocesses. In addition, the components of the user interface 108 canprovide information to external entities. Examples of the componentsthat may be employed within the user interface 108 include keyboards,mouse devices, trackballs, microphones, electrodes, touch screens,printing devices, display screens, and speakers. As discussed above, inone example, providing information to external entities includesdisplaying, communicating, or otherwise conveying a prompt to a patient.In one setting, this may include displaying sign language, such asAmerican Sign Language (ASL), via the user interface 108. In someexamples, the electrodes include an illuminating element, such as anLED. In some examples, the printing devices include printers capable ofrendering visual or tactile (Braille) output. In one example, the userinterface 108 incorporates a Braille mobile device, such as theLevelStar® Braille tablet commercially available from LevelStar LLC ofLouisville, Colo.

In some examples, the user interface 108 is configured to provide acustom prompt interface thorough which the medical device controller 102receives custom prompt data. This custom prompt data may include:identifiers of previously defined prompts, definitions of new prompts,identifiers of previously defined target events that trigger prompts,definitions of new target events that trigger prompts, identifiers ofpreviously defined responses to be addressed, definitions of newresponses to be addressed, identifiers of previously defined actions tobe taken in addressing responses, and definitions of new actions to betaken in addressing responses. In one example, information descriptiveof target events may further include data descriptive of a target timeperiod.

In one example, the custom prompt interface may be used by an authorizedperson, such as a health care professional treating a patient via anexternal medical device, to seek additional information from the patientvia the external medical device. The additional information sought bythe authorized person may include answers to direct, natural languagequestions, as may be presented in a health survey as discussed above. Insome examples, the custom prompt interface may be used by an authorizedperson, such as a support technician, to provide natural language basedinstructions and training to a patient or a third party via the externalmedical device.

To initiate data collection or information distribution via the externalmedical device, the authorized person may access the custom promptinterface via the user interface 108. The custom prompt interface mayemploy a variety of metaphors and user interface elements. In oneexample, the custom prompt interface is rendered via the user interface108 and exchanges information descriptive of instructions to altercustom prompt data stored on the external medical device. In response toreceiving input requesting a change to the custom prompt data of theexternal medical device, the custom prompt interface processes the inputand stores changes to the custom prompt data in a data store of theexternal medical device. Examples of user interface elements provided bythe custom prompt interface are described further below with referenceto FIGS. 7-9. Additional examples of processes executed by the customprompt interface are described further below with reference to FIG. 10.

Other examples may include a variety of features not shown in FIG. 1.For instance, some examples may integrate an accelerometer/acousticsensor and an electrode into a single assembly. In other examples, theaccelerometer/acoustic sensor is integrated within a therapy electrodeassembly. One such arrangement is described further in U.S. patentapplication Ser. No. 14/314,799, titled “THERAPEUTIC DEVICE INCLUDINGACOUSTIC SENSOR,” filed Jun. 25, 2014, which is hereby incorporatedherein by reference in its entirety. In other examples, theaccelerometer/acoustic sensor is integrated within a garment such as thegarment described further below with reference to FIG. 3. For instance,the accelerometer/acoustic sensor may be integrated within a belt, vest,or harness, such as the harness 310 or the belt 350. Thus the examplesdisclosed herein are not limited to a particular number or arrangementof accelerometer/acoustic sensors or electrodes.

Automated Speech Recognition (ASR)

In some implementations, the external medical device can include a voicerecognition engine for detecting a voice of a user (e.g., patient,physician, PSR, or other human entity) and automatically adapting acorresponding output based on the recognition. For example, usingautomated speech recognition (ASR), a patient's verbal response tohealth survey questions can be recorded. In some examples, an originalvoice model can be adapted to individual dictators to improve anaccuracy of the voice recognition engine. For example, in suchapplications, an ASR process can include an initial training/adaptationphase. In the training/adaptation phase, the engine can be adjusted todetect nuances in a speech spectrum based on different kinds ofparameters, such as: the speaker's pitch, tone, etc., (e.g., certainspeech features can be extracted using cepstral and spectral domainanalysis), differentiation of male and female voices, languages,utterance speeds, accents, and/or dialects. In some examples, thetraining can also account for a type of microphone and processing engineused, and an ambience or environmental conditions, including, differentkinds of noise inputs along with the speaker's audio.

In some examples, a process of adaptation to train the speaker's inputfor better ASR efficiency/accuracy can be performed online (e.g., basedon incremental input) or offline (e.g., based on recorded audio batchesas input). An online process can include an adaptation process thatoccurs as and when the speaker is providing inputs into the ASR enginefor recognition. In this example, the engine can learn and adapt to theuser's speech as more inputs and more words of the speaker's audio arebeing recognized. An offline process can include adaptation and/ortraining the ASR engine's models with a set of the speaker's audiocorpora (typically as a batch audio) even before the user starts usingthe engine for recognition or transcription.

For example, in the context of a wearable ambulatory device, the offlineadaptation can consist of a training/adaptation mode where the user isasked to speak some of the regularly used words by the speaker duringthe training. For instance, it may be known in advance that a patientmay provide certain utterances in responding a health survey questions,such as “Yes,” “No,” or “May be,” or in the context of describingphysical feelings, “I am feeling fine,” “I am feeling faint,” “I feeltired,” “My legs hurt.” The patient may also be asked to speak certainwords and/or phrases that can be used during a training or maintenancemode of the device. For example, the patient may state “I can hear thechime now,” or “I cannot feel the vibration.” Similarly, a physicianspecialized in a certain practice, such as cardiology, can be requiredto speak certain words and/or phrases that he or she is likely to use incustomizing, e.g., a health survey. For example, the physician may alsobe required to speak certain medical terms such as “arrhythmia” or“cardiac arrest.” In this manner, the ASR process can be trained for thespecific contexts and environments of use.

In some implementations, another factor that can be used to improve anacoustic model may be based on supervised or unsupervised adaptation. Inthe case of supervised adaptation, there can be an existing baselinetranscript based on how the acoustic models are trained. In unsupervisedadaptation, there may be no transcript and usually the more new wordsare spoken, the better the adaptation for the acoustic models. Inunsupervised adaptation, spoken words can be aligned with a baselinemodel and use the transcribed words for adaptation. Those skilled in theart will understand that, in some examples, a confidence measure can beused to learn whether certain transcribed words may be used foradaptation or not. For example, Hidden Markov Model-based recognitionengines may use an unsupervised or a mixture of supervised/unsupervisedschemes to perform adaptation.

In some examples, an audio input of a predetermined length may be toperform the training. For example, the audio duration may comprise in arange of 1-30 minutes of audio input. Persons of ordinary skill canunderstand that addition processes may be performed on the ASR processto improve quality, including compression, filtering, or other signalprocessing algorithms.

In some examples, the medical device controller 102 is incorporated intoa unitary housing. FIGS. 2A-B illustrate such an example of the medicaldevice controller 102. As shown in FIGS. 2A-B, the medical devicecontroller 102 includes two response buttons 210 on opposing sides ofthe housing. The response buttons 210 are recessed to reduce thelikelihood of accidental activation (e.g., a patient falling on theresponse button). The medical device controller 102 also includes, inthis example, a display screen 220 and a speaker to enable thecommunication of audible and visual stimuli to the patient. It isappreciated that the response buttons 210 do not have to be placed onopposing sides of the housing as illustrated in FIGS. 2A-B. The responsebuttons, for example, may be located adjacent to each other in thehousing the medical device controller 102. The adjacent placement of theresponse buttons may make it easier for individuals with smaller handsor less dexterity to engage the response buttons.

Example Ambulatory Medical Device

In some examples, the external medical device controller 102 describedabove with reference to FIG. 1 is included in a wearable defibrillatorcomprising a garment (e.g., a vest or belt) that is worn by the patient.FIG. 3 illustrates a wearable defibrillator 300 in accord with theseexamples. In at least one example, the wearable defibrillator 300 may bea LifeVest® wearable cardioverter defibrillator available from ZOLLMedical Corporation of Chelmsford, Mass. The wearable defibrillator 300monitors the patient's ECG with sensing electrodes, monitors the patientheart sounds with acoustic sensors, detects life-threateningarrhythmias, records events of interest, and delivers therapy in theform of one or more pacing pulses or a defibrillating shock through thetherapy electrodes if treatment is necessary. As shown in FIG. 3, thewearable defibrillator 300 includes a harness 310 having a pair ofshoulder straps and a belt that is worn about the torso of a patient.The wearable defibrillator 300 includes a plurality of ECG sensingelectrodes 320 that are attached to the harness 310 at various positionsabout the patient's body and electrically coupled to the sensorinterface 114 of the medical device controller 102 via a connection pod324. The plurality of ECG sensing electrodes 320 are coupled to themedical device controller 102 to monitor the cardiac function of thepatient and generally include a anterior/posterior pair of ECG sensingelectrodes and a side/side pair of ECG sensing electrodes. The pluralityof ECG sensing electrodes 320 may incorporate any electrode system,including conventional stick-on adhesive electrodes, dry-sensingcapacitive ECG electrodes, radio transparent electrodes, segmentedelectrodes, or one or more long term wear electrodes that are configuredto be continuously worn by a patient for extended periods (e.g., 3 ormore days). One example of such a long term wear electrode is describedin U.S. Patent Application Publication No. 2013/0325096, titled “LONGTERM WEAR MULTIFUNCTION BIOMEDICAL ELECTRODE,” published Dec. 5, 2013,which is hereby incorporated herein by reference in its entirety.Additional ECG sensing electrodes may be provided, and the plurality ofECG sensing electrodes 320 may be disposed at various locations aboutthe patient's body.

The wearable defibrillator 300 also includes one or moreaccelerometer/acoustic sensors 322 that are attached to a belt 350 ofthe harness 310 at various positions about the patient's body andelectrically coupled to the sensor interface 114 of the medical devicecontroller 102 via the connection pod 324. The one or moreaccelerometer/acoustic sensors 322 are coupled to the medical devicecontroller 102 to monitor the cardiopulmonary function of the patientand generally positioned on the surface of a patient's body in theprecordial area.

Although not shown is FIG. 3, the wearable defibrillator 300 may includeadditional sensors, other than the plurality of ECG sensing electrodes320, capable of monitoring the physiological condition or activity ofthe patient. For example, sensors capable of measuring blood pressure(via, for example, video blood pressure detection), heart rate, heartsounds, thoracic impedance, pulse oxygen level (via, for example,reflectance-based pulse oximetry to determine oxygen concentration),respiration rate, and the activity level of the patient may also beprovided.

The wearable defibrillator 300 also includes a plurality of therapyelectrodes 314 that are electrically coupled to the medical devicecontroller 102 via the connection pod 324 and which are configured todeliver one or more therapeutic defibrillating shocks to the body of thepatient, if it is determined that such treatment is warranted. Eachtherapy electrode of the plurality of therapy electrodes may be housedin a therapy electrode assembly that further includes conductive geldisposed within one or more reservoirs. Prior to delivering therapy, thetherapy electrode assembly may dispense the conductive gel to improveconductivity between the therapy electrode and the body of the patient.The connection pod 324 electrically couples the plurality of ECG sensingelectrodes 320 and the plurality of therapy electrodes 314 to thetherapy delivery interface 116 of the medical device controller 102, andmay include electronic circuitry configured for this purpose. Theconnection pod 324 may also include other electronic circuitry, such asa motion sensor or accelerometer through which patient activity may bemonitored.

As shown in FIG. 3, the wearable defibrillator 300 also includes a userinterface pod 340 that is electrically coupled to, or integrated inwith, the user interface 108 of the medical device controller 102. Theuser interface pod 340 can be attached to the patient's clothing or tothe harness 310, for example, via a clip (not shown) that is attached toa portion of the interface pod 340. In some examples, the user interfacepod 340 may simply be held in a person's hand. In some examples, theuser interface pod 340 may communicate wirelessly with the userinterface 108 of the medical device controller 102, for example, using aBluetooth®, Wireless USB, ZigBee, Wireless Ethernet, GSM, or other typeof communication interface.

Example Automated Medical Device

In some examples, the external medical device controller 102 describedabove with reference to FIG. 1 is included in an automated externalmedical device (AED). AEDs are small portable defibrillators that arecapable of monitoring cardiac rhythms, determining when a defibrillatingshock is necessary, and administering the defibrillating shock eitherautomatically, or under the control of a trained rescuer (e.g., an EMTor other medically training personnel). The AED, in addition, may beconfigured to provide counseling to an operator as to how to performcardiac resuscitation (CPR). FIG. 4 illustrates an AED 400. The AED 400may be, for example, an AED Plus® automated external defibrillatoravailable from ZOLL Medical Corporation of Chelmsford, Mass. As shown,the AED 400 includes the medical device controller 102 and an electrodeassembly 402.

The electrode assembly 402 includes one or more sensing electrodes(e.g., ECG sensors), one or more acoustic sensors 422, one or moretherapy electrodes 404 (e.g., defibrillation pads), a connector 406,wiring 408 electrically coupling the connector 406 to the one or moresensing electrodes 120, the one or more acoustic sensors, and the one ormore therapy electrodes 404. As shown in FIG. 4, the connector isconfigured to couple the electrode assembly 402 to the medical devicecontroller 102 and, more specifically, the one or more sensingelectrodes 420 and the one or more acoustic sensors 422 to the sensorinterface 114 and the one or more therapy electrodes to the therapydelivery interface 116.

The medical device controller 102 of the AED 400 is configured to detectthe cardiac rhythm of the patient using ECG and heart sounds data andprovide pacing and defibrillating shocks to the patient as appropriate.This process is similar to the process described with regard to medicaldevice controller 102 of the ambulatory medical device 300. The userinterface 108 of the AED 400 may include a variety of componentsconfigured to communicate with the operator including, but not limitedto, a display screen, a speaker, and one or more buttons. In thisexample, the AED 400 includes a display screen to display notificationsto an operator. The notifications may provide instructions to theoperator regarding the proper administration of CPR to the patient. Thenotifications on the display may be accompanied by audible alarms fromthe speaker to further assist the operator in administering CPR to thepatient.

In another example, the medical device controller 102 (and moreparticularly, the natural language processing component of FIG. 1) ofthe AED is configured to use processed acoustic data to guide anoperator through a CPR procedure. In this example, the natural languageprocessing component 112 issues step by step instructions to theoperator and analyzes processed electrode data, processed acoustic data,and processed motion data representative of heart sounds, breath sounds,and physical movement (e.g., chest compressions) to validate performanceof each step by the operator. Further, where performance of a given stepis inadequate (e.g., chest compressions are not deep enough), thenatural language processing component 112 may issue additionalinstructions to help the operator adequately perform the given step.

Example Prompting Computer System

As discussed above, some examples provide health survey prompts,training prompts, and instruction prompts to a user that are tailored tothe needs of the user, thus user's language, and the user's situation.FIG. 5 illustrates one of these examples, a distributed prompting system500. As shown, FIG. 5 includes a patient 502, a support technician 504,a health care professional 518, the external medical device 506,computer systems 508 and 520, and communication networks 510 and 522.The computer system 508 includes a custom prompt interface 516. Whileshown in FIG. 5 as included in the distributed prompting system 500, invarious examples the custom prompt interface is incorporated into theexternal medical device 506 and does not require a network connection.The external medical device 506 may include any programmable device (adevice including memory for storing data and at least one processor indata communication with the memory) configured to monitor andpotentially treat patients, such as the external medical devicesdescribed above with reference to FIGS. 3 and 4. As shown in FIG. 5, themedical device 506 includes the medical device controller 102. Themedical device controller 102 includes the network interface 106. Boththe medical device controller and the network interface 106 aredescribed above with reference to FIG. 1. The computer system 508 mayinclude one or more computer systems, such as the computer systemdescribed below with reference to FIG. 6. In particular, the computersystem may include mobile computing devices (e.g., smart phones, tabletcomputers, personal digital assistants, etc.).

As depicted in FIG. 5, the computer system 508 and the external medicaldevice 506 exchange (i.e. send or receive) information via the network510. Similarly, the computer system 520 and the computer system 508exchange information via the network 522. The network 510 or the network522 may include any communication network through which programmabledevices may exchange information. For example, the network 510 or thenetwork 522 may be a public network, such as the internet, and mayinclude other public or private networks such as LANs, WANs, extranets,intranets, and cloud computing systems. The network 510 or the network522 may also include cellular networks such as CMDA, EvDO, GSM, and iDENnetworks. Although the network 510 and the network 522 are illustratedas distinct networks in FIG. 5, examples disclosed herein are notlimited to two distinct networks. The network 510 and the network 522may be a unified, connected network or may include other networkswithout departing from the scope of the examples disclosed herein.

In some examples, an authorized person, such as a health careprofessional 518 treating the patient 502 via the external medicaldevice 506, seeks additional information from the patient 502 via theexternal medical device 506. The additional information sought by theauthorized person may include answers to direct questions, as may bepresented in a health survey as discussed above.

To initiate information collection via the external medical device 506,the health care professional 518 may instruct the support technician 504to alter prompt information of the external medical device by conductingan update process. In some examples, the health care professional 518may communicate these instructions via the custom prompt interface 516.In these examples, the custom prompt interface 516 includes a secure,web based, storage and retrieval system for information gathered byexternal medical devices, such as the external medical device 506. Usingthe custom prompt interface 516, health care professionals (e.g., thehealth care professional 518) can access data for patients (e.g. thepatient 502) wearing devices (e.g., the external medical device 506) andmonitor the patient's medical condition, review responses to prompts,review alert histories, and the like.

In one example illustrated in FIG. 5, the custom prompt interface 516serves a secure user interface to the health care professional 518 viathe network 522 and the computer system 520. The computer system 520renders the user interface and exchanges information descriptive ofinstructions to alter the configuration of the external medical device506 with the health care professional 518. In response to receivinginput requesting a change to the configuration of the external medicaldevice, the custom prompt interface 516 processes the information andprovides the instructions to the support technician 504. To exchangeinformation with the health care professional 518, the custom promptinterface 516 may employ a variety of metaphors and user interfaceelements. Examples of user interface elements served by the customprompt interface 516 and rendered by the computer system 520 aredescribed further below with reference to FIGS. 7-9.

In some examples, and as illustrated in FIG. 5, the computer system 508also renders the custom prompt interface 516 to the support technician504. When rendered to the support technician 504, the custom promptinterface 516 is configured to exchange information with the supporttechnician 504 and the external medical device 506. The informationprocessed by the custom prompt interface 516 may include requests tochange prompt information, requests for authorization, requests forupdate sessions, requests for authentication, requests to initiateupdates, requests to process acknowledgments, and the like. To exchangeinformation with the external medical device 506, the custom promptinterface 516 generates and transmits messages to the external medicaldevice 506 that subscribe to a protocol supported by the externalmedical device 506. To exchange information with the support technician504, the custom prompt interface 516 may employ a variety of metaphorsand user interface elements. For instance, in one example, the customprompt interface 516 includes a support interface with screens and otherelements that, when selected by the support technician 504, prompt thesupport technician 504 to enter a request to change parameters of theexternal medical device 506. Further, in this example, the supportinterface includes elements configured to initiate transmission ofaltered configuration information, including custom prompt data, fromthe computer system 508 to the external medical device 506. Responsiveto receiving the altered configuration information, the external medicaldevice processes the altered configuration information and adjusts itoperation accordingly. Additional examples of processes and acts thatthe distributed prompting system is configured to execute are describedbelow with reference to FIG. 10.

Computer System

As discussed above with regard to FIG. 5, various aspects and functionsdescribed herein may be implemented as specialized hardware or softwarecomponents executing in one or more computer systems. There are manyexamples of computer systems that are currently in use. These examplesinclude, among others, network appliances, personal computers,workstations, mainframes, networked clients, servers, media servers,application servers, database servers, and web servers. Other examplesof computer systems may include mobile computing devices (e.g., smartphones, tablet computers, laptop computers, and personal digitalassistants) and network equipment (e.g., load balancers, routers, andswitches). Examples of particular models of mobile computing devicesinclude iPhones, iPads, and iPod touches running iOS operating systemavailable from Apple, Android devices like Samsung Galaxy Series, LGNexus, and Motorola Droid X, Blackberry devices available fromBlackberry Limited, and Areas Phone devices. Further, aspects may belocated on a single computer system or may be distributed among aplurality of computer systems connected to one or more communicationsnetworks.

For example, various aspects, functions, and processes may bedistributed among one or more computer systems configured to provide aservice to one or more client computers, or to perform an overall taskas part of a distributed system. Additionally, aspects may be performedon a client-server or multi-tier system that includes componentsdistributed among one or more server systems that perform variousfunctions. Consequently, examples are not limited to executing on anyparticular system or group of systems. Further, aspects, functions, andprocesses may be implemented in software, hardware or firmware, or anycombination thereof. Thus, aspects, functions, and processes may beimplemented within methods, acts, systems, system elements andcomponents using a variety of hardware and software configurations, andexamples are not limited to any particular distributed architecture,network, or communication protocol.

Referring to FIG. 6, there is illustrated a block diagram of adistributed computer system 600, in which various aspects and functionsare practiced. As described above with reference to FIG. 5, in at leastone example, the computer system 508 includes one or more distributedcomputer systems such as the computer system 600. As shown in FIG. 6,the distributed computer system 600 includes one more computer systemsthat exchange information. More specifically, the distributed computersystem 600 includes computer systems 602, 604, and 606. As shown, thecomputer systems 602, 604, and 606 are interconnected by, and mayexchange data through, a communication network 608. The network 608 mayinclude any communication network through which computer systems mayexchange data. To exchange data using the network 608, the computersystems 602, 604, and 606 and the network 608 may use various methods,protocols and standards, including, among others, Fibre Channel, TokenRing, Ethernet, Wireless Ethernet, Bluetooth, IP, IPV6, TCP/IP, UDP,DTN, HTTP, FTP, SNMP, SMS, MMS, SS7, JSON, SOAP, CORBA, REST, and WebServices. To ensure data transfer is secure, the computer systems 602,604, and 606 may transmit data via the network 608 using a variety ofsecurity measures including, for example, TLS, SSL, or VPN. While thedistributed computer system 600 illustrates three networked computersystems, the distributed computer system 600 is not so limited and mayinclude any number of computer systems and computing devices, networkedusing any medium and communication protocol.

As illustrated in FIG. 6, the computer system 602 includes a processor610, a memory 612, an interconnection element 614, an interface 616 anddata storage element 618. To implement at least some of the aspects,functions, and processes disclosed herein, the processor 610 performs aseries of instructions that result in manipulated data. The processor610 may be any type of processor, multiprocessor or controller. Someexemplary processors include commercially available processors such asan Intel Xeon, Itanium, Core, Celeron, or Pentium processor, an AMDOpteron processor, an Apple A4 or A5 processor, a Sun UltraSPARC or IBMPower⁵+ processor and an IBM mainframe chip. The processor 610 isconnected to other system components, including one or more memorydevices 612, by the interconnection element 614.

The memory 612 stores programs and data during operation of the computersystem 602. Thus, the memory 612 may be a relatively high performance,volatile, random access memory such as a dynamic random access memory(“DRAM”) or static memory (“SRAM”). However, the memory 612 may includeany device for storing data, such as a disk drive or other nonvolatilestorage device. Various examples may organize the memory 612 intoparticularized and, in some cases, unique structures to perform thefunctions disclosed herein. These data structures may be sized andorganized to store values for particular data and types of data.

Components of the computer system 602 are coupled by an interconnectionelement such as the interconnection element 614. The interconnectionelement 614 may include any communication coupling between systemcomponents such as one or more physical busses in conformance withspecialized or standard computing bus technologies such as IDE, SCSI,PCI and InfiniBand. The interconnection element 614 enablescommunications, such as data and instructions, to be exchanged betweensystem components of the computer system 602.

The computer system 602 also includes one or more interface devices 616such as input devices, output devices and combination input/outputdevices. Interface devices may receive input or provide output. Moreparticularly, output devices may render information for externalpresentation. Input devices may accept information from externalsources. Examples of interface devices include keyboards, mouse devices,trackballs, microphones, touch screens, printing devices, displayscreens, speakers, network interface cards, etc. Interface devices allowthe computer system 602 to exchange information and to communicate withexternal entities, such as users and other systems.

The data storage element 618 includes a computer readable and writeablenonvolatile, or non-transitory, data storage medium in whichinstructions are stored that define a program or other object that isexecuted by the processor 610. The data storage element 618 also mayinclude information that is recorded, on or in, the medium, and that isprocessed by the processor 610 during execution of the program. Morespecifically, the information may be stored in one or more datastructures specifically configured to conserve storage space or increasedata exchange performance. The instructions may be persistently storedas encoded signals, and the instructions may cause the processor 610 toperform any of the functions described herein. The medium may, forexample, be optical disk, magnetic disk or flash memory, among others.In operation, the processor 610 or some other controller causes data tobe read from the nonvolatile recording medium into another memory, suchas the memory 612, that allows for faster access to the information bythe processor 610 than does the storage medium included in the datastorage element 618. The memory may be located in the data storageelement 618 or in the memory 612, however, the processor 610 manipulatesthe data within the memory, and then copies the data to the storagemedium associated with the data storage element 618 after processing iscompleted. A variety of components may manage data movement between thestorage medium and other memory elements and examples are not limited toparticular data management components. Further, examples are not limitedto a particular memory system or data storage system.

Although the computer system 602 is shown by way of example as one typeof computer system upon which various aspects and functions may bepracticed, aspects and functions are not limited to being implemented onthe computer system 602 as shown in FIG. 6. Various aspects andfunctions may be practiced on one or more computers having a differentarchitectures or components than that shown in FIG. 6. For instance, thecomputer system 602 may include specially programmed, special-purposehardware, such as an application-specific integrated circuit (“ASIC”)tailored to perform a particular operation disclosed herein. Whileanother example may perform the same function using a grid of severalgeneral-purpose computing devices running MAC OS System X with MotorolaPowerPC processors and several specialized computing devices runningproprietary hardware and operating systems.

The computer system 602 may be a computer system including an operatingsystem that manages at least a portion of the hardware elements includedin the computer system 602. In some examples, a processor or controller,such as the processor 610, executes an operating system. Examples of aparticular operating system that may be executed include a Windows-basedoperating system, such as, Windows NT, Windows 2000 (Windows ME),Windows XP, Windows Vista or Windows 7 operating systems, available fromthe Microsoft Corporation, a MAC OS System X operating system or an iOSoperating system available from Apple Computer, one of many Linux-basedoperating system distributions, for example, the Enterprise Linuxoperating system available from Red Hat Inc., a Solaris operating systemavailable from Sun Microsystems, or a UNIX operating systems availablefrom various sources. Many other operating systems may be used, andexamples are not limited to any particular operating system.

The processor 610 and operating system together define a computerplatform for which application programs in high-level programminglanguages are written. These component applications may be executable,intermediate, bytecode or interpreted code which communicates over acommunication network, for example, the Internet, using a communicationprotocol, for example, TCP/IP. Similarly, aspects may be implementedusing an object-oriented programming language, such as .Net, SmallTalk,Java, C++, Ada, C# (C-Sharp), Python, or JavaScript. Otherobject-oriented programming languages may also be used. Alternatively,functional, scripting, or logical programming languages may be used.

Additionally, various aspects and functions may be implemented in anon-programmed environment. For example, documents created in HTML, XMLor other formats, when viewed in a window of a browser program, canrender aspects of a graphical-user interface or perform other functions.Further, various examples may be implemented as programmed ornon-programmed elements, or any combination thereof. For example, a webpage may be implemented using HTML while a data object called fromwithin the web page may be written in C++. Thus, the examples are notlimited to a specific programming language and any suitable programminglanguage could be used. Accordingly, the functional components disclosedherein may include a wide variety of elements (e.g., specializedhardware, executable code, data structures or objects) that areconfigured to perform the functions described herein.

In some examples, the components disclosed herein may read parametersthat affect the functions performed by the components. These parametersmay be physically stored in any form of suitable memory includingvolatile memory (such as RAM) or nonvolatile memory (such as a magnetichard drive). In addition, the parameters may be logically stored in apropriety data structure (such as a database or file defined by a usermode application) or in a commonly shared data structure (such as anapplication registry that is defined by an operating system). Inaddition, some examples provide for both system and user interfaces thatallow external entities to modify the parameters and thereby configurethe behavior of the components.

Example Prompting Interfaces

FIG. 7 shows one example interface configured to receive input selectingone or more customized prompts for transmission to an external medicaldevice, such as those discussed above with reference to FIGS. 3 and 4.As shown, the interface 700 includes one or more user interface screenshaving a plurality of tabs 702 each having an associated topic, such as“Alerts”, “Wear Time”, “All Recordings”, “Trends”, “Trend Setup”, “SetupInfo”, “Health Survey Setup”, and “Walk Test Setup”. In furtherexamples, the interface 700 may include tabs not shown in FIG. 7. Userinterface elements associated with each individual tab 702 of theinterface 700 are presented to the user responsive to user selection ofthe individual tab. FIG. 7 shows user selection of the “Health SurveySetup” tab 704.

According to one example, the “Health Survey Setup” tab 704 providescheck boxes, text boxes, scroll boxes, or any other input componentsconfigured to receive selections of user defined customized prompts. Asshown in FIG. 7, users may define health survey prompts including one ormore questions. In one example, the “Health Survey Setup” tab 704includes a listing of prompts 706 to communicate to a patient usingnatural language (e.g., audio prompts). Various prompts 706 may be,e.g., predefined and displayed in a listing, each having an associatedcheck box 708 selectable by the user. Responsive to user selection of anassociated check box 708, the interface 700 may display a confirmationsymbol (e.g., check mark) proximate the check box 708 of the prompt 706selected. User selection of individual prompts 706 permits the user ofthe interface 700 to customize a prompt-based health survey to becommunicated to an associated patient. Tab 704 is shown as including atleast the following prompts 706: “How many pillows did you sleep on lastnight?”; “Has your weight changed from yesterday?”; “How much activityhave you averaged in the past few days?”; “Have you felt dizzy”; “Areyou feeling fatigued”; “Are you having difficulty climbing the stairs?”;“Have you felt your heart racing”; “Have you felt your heart beatingirregularly?”; “Are you short of breath?”; “Do you have swelling in yourankles and legs?”; “Have you had any chest pain?”; and “Have you missedany medications”, but the examples disclosed herein are not be limitedto these prompts 706.

In various examples, the interface 700 may include one or more textboxes configured to add a new prompt to the listing responsive toreceiving an input of the new custom prompt in the text box.Accordingly, a user of the system may customize the listing of prompts706 shown in the “Health Survey Setup” tab 704. In some examples, userscan be granted different access-levels to modify the prompt data. Suchuser access-levels can result in certain rights being granted to usersof the interface 700. For example, access-level rights can be managedusing default or specified access control features provided in anoperating system of the medical device controller. For example, aphysician may be granted rights to edit the content of the customprompts 706 and/or specify new prompts. A nurse, on the other hand, maybe restricted to only selecting one or more predefined prompts 706 thatwere, e.g., previously set by the physician.

According to one example, the “Health Survey Setup” tab 704 includes adisable feature switch 710, a daily switch 712, and a weekly switch 714.Responsive to user selection of the disable switch 710, the daily switch712, or the weekly switch 714, one or more components of an externalmedical device, such as the controller 102 discussed above with regardsto FIG. 1, are configured to communicate, or refrain from, communicatingthe user selected prompts 706 via the external medical device. Userselection of the disable switch 710 configures the external medicaldevice to not communicate a health survey, user selection of the dailyswitch 712 configures the external medical device to issue the selectedprompts on a daily schedule, and user selection of the weekly switchconfigures the external medical device to issue the selected prompts ona weekly schedule. While not shown, in further examples the interfacemay include a scheduling calendar, or one or more text boxes configuredto receive dates or times at which to communicate the user selectedprompts. In still further examples, the interface 700 may permit theuser to select periods of delay for which the refrain fromcommunicating. For example, a user may select via the interface 700 torefrain from communicating the prompts 706 during the nighttime hours of1 AM to 5 AM. As discussed further below with reference to FIG. 10, theinterface 700 may store the scheduling information discussed abovewithin custom prompt data as one or more target events (e.g., prompttimes) associated with the prompts.

According to one example, the “Health Survey Setup” tab 704 includes anumber of iterations display 716 including an indefinitely switch 718and an enter number switch 720. The enter number switch 720 may have anassociated enter number text box 722. Responsive to user selection ofthe indefinitely switch 718 or the enter number switch 720, one or morecomponents of an external medical device, such as the controller 102discussed above with regards to FIG. 1, are configured to communicatethe user selected custom prompts 706 via an associated external medicaldevice for a number of iterations. User selection of the indefinitelyswitch 718 configures the external medical device to communicates theuser selected prompts 706 in perpetuity (i.e., until the externalmedical device is reconfigured to placed out of service), whereas userselection of the enter number switch 720 configures the external medicaldevice to communicate the selected prompts 706 the number of timesidentified by the user in the enter number text box 722. Accordingly,the user of the interface 700 may predetermine the volume ofcommunications sent to the external medical device.

In one example, the “Health Survey Setup” tab 704 further includes asave indicator 724 configured to store user selections and preferencesresponsive to activation of the save indicator 724. For example, userselections may be stored in profiles accessible through a drop-downmenu, such as menu 726. As shown in FIG. 7, responsive to user selectionof the drop down menu 726, the interface 700 may present the user withone or more profiles of stored user selections. Profiles may bepresented via a single selectable identifier, such as a date, name,user, health condition, health care provider, etc. Responsive toselection of the identifier, the interface 700 pre-populates the userselectable options (e.g., prompts 706, disable feature switch 710, dailyswitch 712, weekly switch 714, etc.) in the “Health Survey Setup” tab704. Accordingly, users of the interface 700 may save and return toprompt 706 selections at any time. Alternatively, the interface 700 mayinclude a List Manager indicator 728. Responsive to selection of theList Manager indicator 728, the interface 700 may display acomprehensive listing of all the stored profiles of stored userselections.

Turning now to FIG. 8, shown is a “Health Survey Results Review” tab802. As discussed herein, one or more examples store data descriptive ofone or more prompts to be provided to a user to initiate a response fromthe user. According to one example, the “Health Survey Setup” tab 704provides check boxes, text boxes, scroll boxes, lists, areas, and anyother display permitting a user to view and interact with customizedprompts and associated responses.

In one example, the “Health Survey Results Review” tab 802 includes alisting of prompts 804. In various examples, the listing of prompts 804may be included in a survey. As discussed above with reference to FIG.7, prompts 804 may include customized health survey prompts includingone or more questions. In various examples, the listing of prompts 804includes the prompts 706 selected by the user in Health Survey Reviewtab 702. The “Health Survey Results Review” tab 802 may additionallypresent a listing of responses 806. In various examples, each response806 corresponds to a prompt 804 in the listing of prompts. For example,each response 806 may include an answer to the question posed by theassociated prompt 804. For purpose of illustration, the response to theprompt “How many pillows did you sleep on last night?” is “1”. Responses806 may include a description of an answer received from a patient of anexternal medical device. In various examples, this may include, numbers,colors, descriptive words, phrases, times, addresses, sentences, noises,sounds, yes/no answers, and etc. While not shown in FIG. 8, the “HealthSurvey Results Review” tab 802 may further include one or morenavigational tools permitting the user to navigate through the listingof prompts 804 or responses 806.

In one example, the Health Survey Results Review tab 802 furtherincludes a date performed scroll box 808, including a listing of thedates and times at which prompts 804 were communicated, or responses 806were received. As shown in FIG. 8, the date performed scroll box 808 maydisplay each listing of prompts 804 and responses 806 having aparticular date or time via a date identifier 810. Responsive toselection of the date identifier 810, the “Health Survey Results Review”tab 802 is configured to display the listing of prompts 804 andresponses 806 associated with that selected time period. Accordingly,the date performed scroll box 808 permits the user to navigate betweenlistings of prompts 804 and associated listings of responses 806.

In one example, the “Health Survey Results Review” tab 802 furtherincludes an additional health surveys 812 feature. In one example thismay include a previous indicator 814. Responsive to user selection ofthe previous indicator 814, the “Health Survey Results Review” tab 802presents a previously performed listing of prompts and responses. Asdiscussed above, this listing may include a previously performed survey.For example, the previously performed survey may include repeatedprompts at an earlier date, or prompts and responses for a commonpatient. Accordingly, the Health Survey Results Review tab 802 may alsodisplay an indicator 816 of the amount of surveys performed for aparticular patient.

In one example, the “Health Survey Results Review” tab 802 may furtherinclude a trend indicator 818. Responsive to user selection of the trendindicator, the interface 700 may cause trends in patient responses andother trends related data to be displayed (e.g., user interface elementsassociated with the “Trends” tab shown in FIGS. 7-8).

Turning now to FIG. 9, shown is a “Trend” tab 902. In various examples,the “Trend” tab 902 presents one or more visual representations ofresponses, such as the responses 806 of FIG. 8, for a particular prompt904, such as prompts 706 or prompts 804, over a period of time. Invarious examples, the “Trend” tab 902 includes a visual representationfor each prompt included in a listing of prompts, such as a survey. Asshown in FIG. 9, visual representations may include graphs, charts,figures, and images, among other graphic representations. In particular,FIG. 9 shows a first visual representation 906 of responses to theprompt “How many pillows did you sleep on last night?” Responses forthis prompt are indicated along the vertical axis 908 of the firstvisual representation 906 and dates at which the responses were receivedare located along the horizontal axis 910. The “Trend” tab 902 mayfurther include a selectable indicator 912 permitting the user to showthe particular response associated with an individual date. Responsiveto user selection of the selectable indicator 912, the “Trend” tab 902presents one or more windows including the details of the particularresponse associated with a date. The details may be presented in a list,as shown in FIG. 8, or in any other arrangement. The “Trend” tab 902 mayfurther include a navigation bar 914. Responsive to user translation ofthe navigation bar 914, the “Trend” tab is configured to proportionatelynavigate about the first visual representation 906.

As shown in FIG. 9, the “Trend” tab 902 may also include a second visualrepresentation. In particular, FIG. 9 shows a second visualrepresentation 916 of responses to the prompt “Has your weight changedfrom yesterday?” Responses for this prompt are indicated along thevertical axis 918 of the second visual representation 916 and dates atwhich the responses were received are located along the horizontal axis920. The “Trend” tab 902 may further include a selectable indicator 922permitting the user to show the particular response associated with anindividual date and a navigation bar 924 permitting the user to navigatethe second graphical representation 916.

In various examples, the “Trend” tab 902 may further include a returnindicator 926. Responsive to user selection of the return indicator, theinterface 700 may cause the Health Survey Results Review tab 802 of FIG.8 to be redisplayed.

It is appreciated that, in some examples, the entirety of the userinterface screens presented in FIGS. 7-9 may be implemented as a seriesof prompts processed by a natural language processor, such as thenatural language processor 112 described above with reference to FIG. 1.For instance, the prompts described above with reference to the promptlist 708 may be issued by an external medical device as audio or tactileprompts. Verbal responses to these prompts may be processed and theresults recorded to configure a health survey for a particular patient.

Example Prompting Processes

Various examples implement processes through which an external medicaldevice prompts a target recipient using natural language. These promptsmay take the form of questions in a health survey or instructions andtraining, among other forms. FIG. 10 illustrates one such promptingprocess 1000 in which a distributed prompting system, such as thedistributed prompting system 900 described above with reference to FIG.9, receives customized prompts and distributes the customized prompts toone or more external medical devices for subsequent output. In thisexample, the external medical device may be configured in accord withthe external medical device 300, the external medical device 400, oranother external medical device. Further, the external medical devicemay include a medical device controller, such as the medical devicecontroller 102 described above with reference to FIG. 1.

As shown in FIG. 10, the prompting process 1000 begins with provision ofa custom prompt interface in act 1002. The custom prompt interface mayinclude a variety of user interface elements rendered according tovarious designs. In some examples, the computer system 520 describedabove with reference to FIG. 5 renders the custom prompt interface 516.In some examples, the computer system 508 renders the custom promptinterface via a local user interface (e.g., connected via WiFi to alocal LAN for access on a computer terminal in the hospital). In someimplementations, the custom prompt interface may be disposed on themedical device itself to facilitate local configuration and set-up. Inone example where the custom prompt interface is directed to healthsurvey prompts, the custom prompt interface renders a user interfacescreen in accord with the user interface screens described above withreference to FIGS. 5-7. As described above, in some examples, theinformation presented in these user interface screens is rendered asnatural language prompts (e.g., audio prompts or visual prompts in theform of sign language). In some examples, the custom prompt interfaceprovides information regarding selectable health survey prompts. In someexamples, the custom prompt interface provides information regardingselectable instruction prompts. In some examples, the custom promptinterface provides information regarding selectable training prompts. Insome examples, the custom prompt interface provides user interfaceelements configured to receive text or other input specifying andselecting new prompts to be transmitted to the external medical device.

In act 1004, the custom prompt interface receives custom prompt inputfrom a user, such as the health care professional 518 or the supporttechnician 504 described above with reference to FIG. 5. This customprompt input may be in any form detectable by a computer system.Examples of custom prompt input include entered text, one or moreselections of user interface elements, and the like. For instance, withreference to FIG. 5, the custom prompt input may include a selection ofa check box corresponding to a prompt. In response to receiving thecustom prompt input, the custom prompt interface stores datarepresentative of the input in a data store, such as may be implemented,for example, in computer readable memory or computer readable datastorage. In some examples, the data representative of the input isstored for subsequent processing as custom prompt data.

In optional act 1006, the custom prompt interface transmits customprompt data to the external medical device. In cases where the customprompt data is stored locally, e.g., within a data storage element inthe medical device controller, this act 1006 can be skipped. This customprompt data may include identifiers of previously defined prompts,definitions of new prompts, identifiers of previously defined targetevents that trigger prompts, definitions of new target events thattrigger prompts, identifiers of previously defined responses to beaddressed, definitions of new responses to be addressed, identifiers ofpreviously defined actions to be taken in addressing responses, anddefinitions of new actions to be taken in addressing responses. Thetransmission of the custom prompt data may be performed using a varietyof components that support various protocols, such as via email, FTP, ormore specialized transmission techniques. In some examples, the customprompt data is transmitted to the external medical device as a change toconfiguration information within a secure update process, such as theupdate processes described in U.S. Patent Application Publication2013/0231711, titled “SYSTEMS AND METHODS FOR CONFIGURING A WEARABLEMEDICAL MONITORING AND/OR TREATMENT DEVICE,” published Sep. 5, 2013,which is hereby incorporate herein by reference in its entirety.

In optional act 1008, the external medical device receives the customprompt data and stores the custom prompt data in a data store. Inimplementations where the custom prompt data is stored locally, this act1008 can be skipped. In some examples, the external medical devicerepeatedly executes the act 1008 while executing other acts to ensurethat any custom prompt data transmitted by the custom prompt interfaceis received and stored in the external medical device.

In act 1010, the external medical device parses the custom prompt datato identify target events that trigger one or more prompts. These targetevents may include any occurrence that is detectable by the externalmedical device. Examples of target events include presence of targetenvironmental characteristics, presence of target physical conditions ofa patient, presence of target operational statuses of the externalmedical device, presence of target time periods, and the like. In oneparticular example, the custom prompt data specifies the target timeperiod. In additional examples, the custom prompt data omits the targettime period and a default time period is identified.

In act 1012, the external medical device attempts to detect a targetevent. If the external medical device detects a target event, theexternal medical device proceeds to act 1014. In the act 1014, theexternal medical device issues one or more prompts triggered by thetarget event to one or more target recipients identified within theprompt definition. Also within the act 1014, the external medical devicereturns to the act 1010 and parses any newly received custom promptdata.

By monitoring for events in the act 1012, the external medical devicemay issue prompts in the act 1014 upon receipt (e.g., where the event isdetection of the readiness of the external medical device to issue theprompt), according to a schedule (e.g., where the event is detection ofthe current time being within a targeted time period), in response toindications of potential health conditions of a patient as detected byany of the sensors of the external medical device described herein(e.g., i a cardiac arrhythmia, shortness of breath, garbled speech, orother patient abnormality), in response to maintenance being performedon the external medical device (e.g., wherein the event is detection ofa battery, such as the battery 110 described above with reference toFIG. 1, being replaced), or upon detection of other target events.Further, within the act 1012, if the external medical device does notdetect a target event, the external medical device returns to the act1010 and parses any newly received custom prompt data.

The prompts may be delivered as synthesized speech by, for example,converting textual input provided through the custom prompt interface tospeech in a language understandable by the patient. For example, atext-to-speech converter may be employed to perform the voice synthesis,e.g., a reproduction of human speech. In this example, the text may beanalyzed. The custom prompt may comprise an utterance composed of wordsand/or phrases, which may be linguistically analyzed for, e.g., phasing,intonation, and duration, to result in an utterance composed ofphonemes. Through the analysis of the phonemes, speech wave forms may begenerated to output the spoken prompts.

In some examples, the prompts may be delivered by an on-screen animationor illustration of a person performing sign language. As noted above,the custom prompts may be decomposed into words and/or phrases forfurther conversion to a suitable format for sign language processing(e.g., to output to a patient via American sign language). Divisions aregenerally made using separators such as punctuation marks and spaces inthe text; however, in some implementations divisions may includemultiple words, such as a phrase. Once decomposed, individual wordsand/or phrases may be matched to a database of animations or on-screenillustrations of sign language corresponding to each of the individualwords or phrases. Through the analysis of the custom prompt, thecorresponding illustrations of sign language or on-screen animations maybe displayed to the patient.

In other examples, the prompts may be delivered by a printing device asa tactile output (Braille). As described above, the custom prompts maybe decomposed into letters, words, phrases, and/or punctuation forfurther conversion to a suitable format for tactile language processing(e.g., to output to a patient via Braille). In contrast to reproductionsof human speech or illustrations of sign language, custom prompts to berendered as tactile output may be deconstructed into individual lettersand punctuation marks. Once deconstructed, individual letters andpunctuation marks are matched to a database of Braille letters andpunctuation marks and reassembled to form words, phrases, and sentences.Through analysis and transposition of the custom prompt to Braille, atactile output may be printed and delivered to a patient who is unableto otherwise hear a speech waveform or see an illustrated animation.

In act 1016, the external medical device attempts to detect a responsewithin a predetermined period of time specified by a configurableparameter. If the external medical device detects a response within thepredetermined period of time, the external medical device proceeds toact 1018. If the external medical device does not detect a responsewithin the predetermined period of time, the external medical deviceproceeds to act 1024.

In act 1018, the external medical device stores data representative ofthe response in a data store. In act 1020, the external medical devicedetermines whether the response received is a target response to beaddressed by the external medical device (e.g., as defined within thecustom prompt data). Examples of addressable events include events thatindicate a patient is in need of assistance (as detected by any of thesensors of the external medical device described herein) and events thatindicate the external medical device is in need of repair ormaintenance.

If the external medical device determines that the response isaddressable, the external medical device addresses the response in act1022. In addressing a response, the external medical device may alter acourse of treatment (e.g., delay a therapeutic shock or expedite atherapeutic shock), adjust a configurable operational parameter of theexternal medical device, prompt a third party to take action via anatural language prompt (e.g., call an emergency service and report theevent and information regarding the patient, such as location, identity,and vital signs, to the service), or prompt a user to take action via anatural language prompt (e.g., change a battery).

In the act 1024, the external medical device reports the results of theprompting process 1000. FIGS. 8 and 9 illustrate user interface screensprovided by the external medical device for this purpose according tosome examples.

In some examples, execution of the acts 1006 and 1008 is not required.For instance, where the acts 1002 and 1004 are executed by the externalmedical device, rather than a distinct computer system, the customprompt data is stored locally on the external medical device, therebyeliminating the need to execute the acts 1006 and 1008.

Process 1000 depicts one particular sequence of acts in a particularexample. The acts included in this process may be performed by, orusing, one or more computer systems specially configured as discussedherein. Some acts are optional and, as such, may be omitted in accordwith one or more examples. Additionally, the order of acts can bealtered, or other acts can be added, without departing from the scope ofthe systems and methods discussed herein. Furthermore, as discussedabove, in at least one example, the acts are performed on a particular,specially configured machine, namely a medical device configuredaccording to the examples disclosed herein.

In some examples, the external medical devices described herein may usecustom prompts as part of a physical activity test (e.g., a six minutewalk test) administered to the patient. The external medical device maybe employed to monitor the gait of the patient while the patient walks.In these examples, the custom prompts may be communicated to guide thepatient throughout the physical activity test, ascertain patientconditions prior to, during, and after the test, and provide warningsfor emergency conditions occurring during the test. Custom prompts mayrequest, for example, shortness of breath information and fatigueinformation. Furthermore, warnings may include alerts and instructionsto cease the physical activity test because of detected indicators of acardiac arrest or other health problems. These physical activity testsmay include, for example, a six minute walk test as described in U.S.patent application Ser. No. 12/833,173, titled “WEARABLE MEDICALTREATMENT DEVICE WITH MOTION/POSITION DETECTION,” filed Jul. 9, 2010,which is hereby incorporated herein by reference herein in its entirety,and the paper “Guidelines for the Six-Minute Walk Test” published by theAmerican Thoracic Society in March 2002, which is hereby incorporatedherein by reference herein in its entirety.

Having thus described several aspects of at least one example of thisdisclosure, it is to be appreciated various alterations, modifications,and improvements will readily occur to those skilled in the art. Suchalterations, modifications, and improvements are intended to be part ofthis disclosure, and are intended to be within the scope of thedisclosure. Accordingly, the foregoing description and drawings are byway of example only.

What is claimed is:
 1. An external medical device comprising: a memory;and circuitry, in communication with the memory, to: receive inputspecifying at least one prompt relating to a health survey for apatient, the at least one prompt being customized to the patient;convert the at least one prompt to an audio representation; and performthe health survey by at least delivering to the patient the audiorepresentation.
 2. The external medical device of claim 1, wherein theexternal medical device comprises a non-invasive medical device.
 3. Theexternal medical device of claim 1, wherein the external medical devicecomprises an ambulatory medical device capable of and designed formoving with the patient.
 4. The external medical device of claim 1,wherein the external medical device includes components to becontinuously worn by a patient.
 5. The external medical device of claim1, wherein the circuitry includes circuitry to provide a user interfaceincluding a set of selectable prompts directed to a condition of thepatient.
 6. The external medical device of claim 1, wherein thecircuitry includes circuitry to: determine, based on the input, a timeperiod for the health survey comprising the at least one prompt relatingto the health survey; and schedule the health survey for the patientduring the time period.
 7. The external medical device of claim 6,wherein the circuitry includes circuitry to determine the time periodbased on an operating mode of the device.
 8. The external medical deviceof claim 6, wherein the circuitry includes circuitry to determine thetime period based on an operating mode of the device, wherein theoperating mode includes a health survey mode and the time period basedon the health survey mode is as soon as possible.
 9. The externalmedical device of claim 6, wherein the input specifies the target timeperiod.
 10. The external medical device of claim 6, wherein the inputomits the target time period and the circuitry includes circuitry tostore the target time period as a default time period.
 11. The externalmedical device of claim 1, wherein the circuitry includes circuitry tooutput the at least one audio representation during the target timeperiod.
 12. The external medical device of claim 1, wherein thecircuitry includes circuitry to: receive at least one response to the atleast one prompt; record the at least one response; determine resultsbased on the at least one response; and provide the results to anexternal entity via the user interface.
 13. The external medical deviceof claim 12, wherein the circuitry to receive the at least one responseincludes circuitry to process audio representations.
 14. The externalmedical device of claim 1, wherein the circuitry includes circuitry to:receive at least one response to the at least one prompt; and output anaudio representation of at least one other prompt based on the at leastone prompt and the at least one response.
 15. The external medicaldevice of claim 1, wherein the at least one prompt includes a pluralityof prompts.
 16. The external medical device of claim 1, wherein thecircuitry includes a global positioning system (GPS) receiver andcircuitry to receive a location identifier from the GPS receiver, todetermine a language associated with the location, and the audiorepresentation is converted to the language.
 17. The external medicaldevice of claim 1, wherein the target time period includes a reoccurringtime period.
 18. The external medical device of claim 1, wherein thecircuitry includes circuitry to: receive at least one response to the atleast one prompt; identify the at least one response as at least oneaddressable response; and address the response.
 19. The external medicaldevice of claim 1, further comprising a cross-reference stored in thememory, the cross-reference including associations between responsetypes and addresses for target recipients, wherein the circuitryincludes circuitry to receive at least one response to the at least oneprompt, to identify at least one response type of the at least oneresponse, to identify at least one address for at least one targetrecipient from the cross-reference using the at least one response type,and to transmit at least one notification to the at least one targetrecipient.
 20. The external medical device of claim 1, furthercomprising a cross-reference stored in the memory, the cross-referenceincluding associations between response types and addresses for targetrecipients, wherein the circuitry includes circuitry to receive at leastone response to the at least one prompt, to identify at least oneresponse type of the at least one response, to identify at least oneaddress for at least one target recipient from the cross-reference usingthe at least one response type, and to transmit at least onenotification to the at least one target recipient, the target recipientbeing a device associated with at least one of a healthcare provider,support provider, and care taker and the notification including annatural language representation of at least one of a name of thepatient, a location of the patient, a condition of the patient, and theat least one response.
 21. The external medical device of claim 1,further comprising a cross-reference stored in the memory, thecross-reference including associations between response types andpriorities for subsequent actions, wherein the circuitry includescircuitry to receive at least one response to the at least one prompt,to identify at least one response type of the at least one response, toidentify at least one priority from the cross-reference using the atleast one response type, and to transmit at least one notification withthe at least one priority.
 22. An external medical device comprising: amemory; and circuitry, in communication with the memory, to: monitor oneor more indicators of a patient's health; detect a potential healthcondition based on the one or more indicators; identify at least oneprompt associated with the potential condition; generate audio outputconveying the at least one prompt; receive a response to the at leastone prompt; and adjust a configurable parameter of the external medicaldevice based on the at least one prompt and the response.
 23. Theexternal medical device of claim 22, wherein the one or more indicatorsinclude one or more indicators of cardiac function, respiratoryfunction, and vocal function.
 24. The external medical device of claim22, wherein the configurable parameter defines a course of treatmentexecuted by the external medical device to treat the potential healthcondition.
 25. The external medical device of claim 22, wherein thepotential health condition includes at least one of ventriculartachycardia, ventricular fibrillation, bradycardia, and asystole.
 26. Asystem comprising: a computer system including a memory and circuitry,in communication with the memory, to: provide a user interface includinga set of selectable prompts directed to a condition of an externalmedical device, each selectable prompt of the set of selectable promptscorresponding to text articulating the selectable prompt; receive inputselecting at least one prompt from the set of selectable prompts toinclude in a training message directed to the condition; and transmitthe training message to the external medical device; and the externalmedical device, wherein the external medical device comprises a memoryand circuitry, in communication with the memory, to: receive thetraining message; convert the text corresponding to the at least oneprompt to at least one natural language representation of the at leastone prompt; and output the at least one natural language representation.27. The system of claim 26, wherein the condition includes a low batteryand the at least one prompt includes a request to change the battery.